Evaluation and management of spinal epidural abscess

被引:15
作者
DeFroda, Steven F. [1 ]
DePasse, J. Mason [1 ]
Eltorai, Adam E. M. [2 ]
Daniels, Alan H. [3 ]
Palumbo, Mark A. [3 ]
机构
[1] Brown Univ, Alpert Med Sch, Dept Orthopaed, 593 Eddy St, Providence, RI 02903 USA
[2] Brown Univ, Alpert Med Sch, Providence, RI 02912 USA
[3] Brown Univ, Alpert Med Sch, Dept Orthopaed, Div Spine Surg, Providence, RI 02912 USA
关键词
CLINICAL PRESENTATION; EMERGENCY-DEPARTMENT; SURGICAL-MANAGEMENT; INFECTION; RISK; BONE;
D O I
10.1002/jhm.2506
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Spinal epidural abscess (SEA) is an uncommon and potentially catastrophic condition. SEA often presents a diagnostic challenge, as the classic triad of fever, spinal pain, and neurological deficit is evident in only a minority of patients. When diagnosis is delayed, irreversible neurological damage may ensue. To minimize morbidity, an appropriate level of suspicion and an understanding of the diagnostic evaluation are essential. Infection should be suspected in patients presenting with axial pain, fever, or elevated inflammatory markers. Although patients with no known risk factors can develop SEA, clinical concern should be heightened in the presence of diabetes, intravenous drug use, chronic renal failure, immunosuppressant therapy, or a recent invasive spine procedure. When the clinical profile is consistent with the diagnosis of SEA, gadolinium-enhanced magnetic resonance imaging of the spinal column should be obtained on an emergent basis to delineate the location and neural compressive effect of the abscess. Rapid diagnosis allows for efficient treatment, which optimizes the potential for a positive outcome. Journal of Hospital Medicine 2016;11:130-135. (c) 2015 Society of Hospital Medicine
引用
收藏
页码:130 / 135
页数:6
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